Floryt van Wesel

Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis

BACKGROUND It is unclear how many children and adolescents develop post-traumatic stress disorder (PTSD) after trauma. AIMS To determine the incidence of PTSD in trauma-exposed children and adolescents as assessed with well-established diagnostic interviews and to examine potential moderators of the estimate. METHOD A systematic literature search identified 72 peer-reviewed articles on 43 independent samples (n = 3563). Samples consisting only of participants seeking or receiving mental health treatment were excluded. Main analyses involved pooled incidence estimates and meta-analyses of variance. RESULTS The overall rate of PTSD was 15.9% (95% CI 11.5-21.5), which varied according to the type of trauma and gender. Least at risk were boys exposed to non-interpersonal trauma (8.4%, 95% CI 4.7-14.5), whereas girls exposed to interpersonal trauma showed the highest rate (32.9%, 95% CI 19.8-49.3). No significant difference was found for the choice of assessment interview or the informant of the assessment. CONCLUSIONS Research conducted with the best available assessment instruments shows that a significant minority of children and adolescents develop PTSD after trauma exposure, with those exposed to interpersonal trauma and girls at particular risk. The estimates provide a benchmark for DSM-5 and ICD-11.

Building child trauma theory from longitudinal studies: a meta-analysis.

Many children are exposed to traumatic events, with potentially serious psychological and developmental consequences. Therefore, understanding development of long-term posttraumatic stress in children is essential. We aimed to contribute to child trauma theory by focusing on theory use and theory validation in longitudinal studies. Forty studies measuring short-term predictors and long-term posttraumatic stress symptoms were identified and coded for theoretical grounding, sample characteristics, and correlational effect sizes. Explicit theoretical frameworks were present in a minority of the studies. Important predictors of long-term posttraumatic stress were symptoms of acute and short-term posttraumatic stress, depression, anxiety, and parental posttraumatic stress. Female gender, injury severity, duration of hospitalization, and elevated heart rate shortly after hospitalization yielded small effect sizes. Age, minority status, and socioeconomic status were not significantly related to long-term posttraumatic stress reactions. Since many other variables were not studied frequently enough to compute effect sizes, existing theoretical frameworks could only be partially confirmed or falsified. Child trauma theory-building can be facilitated by development of encouraging journal policies, the use of comparable methods, and more intense collaboration.

Salivary cortisol and dehydroepiandrosterone sulfate in adolescent rape victims with post traumatic stress disorder.

BACKGROUND In chronic sexual abuse victims with post traumatic stress disorder (PTSD), the hypothalamic pituitary adrenal (HPA) axis can be dysregulated. In single rape victims, PTSD symptoms are hypothesized to function as a chronic stressor leading to similar HPA-axis dysregulation. The objective of the current study was to assess HPA-axis functioning in female adolescents with rape-related PTSD, but no prior sexual trauma, in comparison to non-victimized controls. METHOD Salivary cortisol and dehydroepiandrosterone sulfate (DHEAS) were measured in 52 female adolescent rape victims with PTSD and 37 healthy adolescents at 0, 15, 30, 45 and 60 min after awakening, both under basal conditions and after 0.5 mg dexamethasone administration. RESULTS Compared to age-matched controls, adolescent rape victims with PTSD showed significantly reduced cortisol and DHEAS levels. No group differences for the effect of dexamethasone suppression were found. Both the event of rape and PTSD diagnosis, and not factors such as sleep duration, smoking, education or oral contraceptives, accounted for the neuroendocrine differences between rape victims and controls. CONCLUSIONS The results show evidence for a dysregulated HPA-axis in female adolescent victims of single sexual trauma with PTSD. The finding of hypocortisolism is consistent with endocrine dysfunctioning in chronic sexual abuse victims and may have clinical implications with regard to treatment possibilities.

Making a difference: towards a method for weighing the evidence in a qualitative synthesis.

OBJECTIVES In a qualitative synthesis, primary qualitative studies are integrated to develop a theory or evidence-based interventions. Until now, the strength of the evidence in the primary studies has not been taken into account in the outcome of the qualitative synthesis. In this paper, a method is developed and evaluated to assign weights to the findings of the qualitative studies using both the frequency and the quality of the reported results. METHOD Seventeen qualitative studies were retrieved in an illustrative example project on children and trauma. Findings were extracted from the primary studies with the use of coding which resulted in 14 themes. The quality of the studies was appraised using both expert judgement and a quality checklist. These outcomes are used to calculate the weights. RESULTS When the outcomes of the checklist appraisal are compared with those of the expert judgement, the effect on the strength of the evidence is virtually always in the same direction. We found that as the frequency with which a concept is studied is low, the strength of the evidence oftentimes decreases even further when using the quality of the results in the weighing process. CONCLUSIONS In the end, the outcomes of a critical appraisal affect the weight that is placed on particular studies. The use of a checklist is recommended because of its more distinguishing ability. The method that was developed for assigning weights to the evidence is discussed in light of both the quality appraisal in qualitative research and the objectives of qualitative synthesis.

Do we know what we test and do we test what we want to know

Null hypothesis testing (NHT) is the most commonly used tool in empirical psychological research even though it has several known limitations. It is argued that since the hypotheses evaluated with NHT do not reflect the research-question or theory of the researchers, conclusions from NHT must be formulated with great modesty, that is, they cannot be stated in a confirmative way. Since confirmation or theory evaluation is, however, what researchers often aim for, we present an alternative approach that is based on the specification of explicit, informative statistical hypotheses. The statistical approach for the evaluation of these hypotheses is a Bayesian model-selection procedure. A non-technical explanation of the Bayesian approach is provided and it will be shown that results obtained with this method give more direct answers to the questions asked and are easier to interpret. An additional advantage of the offered possibility to formulate and evaluate informative hypotheses is that it stimulates researchers to more carefully think through and specify their expectations.

The contribution of mixed methods research to the field of childhood trauma: a narrative review focused on data integration

In mixed methods research (MMR), integrating the quantitative and the qualitative components of a study is assumed to result in additional knowledge (or “yield”). This narrative review examines the extent to which MMR is used in the field of childhood trauma and provides directions for improving mixed methods studies in this field. A systematic literature search resulted in 13 studies that were achieving four different research objectives: (a) measures and meaning, (b) intervention evaluation, (c) theory building, and (d) measurement instrument development and validation. Although some studies produced yield by integrating the components, there is room for improvement and better use of MMR’s potential. We conclude by presenting recommendations for improving the application and dissemination of MMR in childhood trauma.

Rape-related symptoms in adolescents: short- and long-term outcome after cognitive behavior group therapy

Background Efficacy studies on treatment in adolescent victims of single rape are lacking, even though sexual victimization is most likely to occur during adolescence and despite the fact that adolescents are at risk to develop subsequent posttraumatic stress disorder. Aim The aim of this prospective observational study was to evaluate the short- and long-term outcomes of a nine-session cognitive behavior group therapy (STEPS), including a parallel six-session parents’ group on rape-related symptomatology in female adolescents (13–18 years). STEPS includes psychoeducation, exposure in sensu as well as in vivo, cognitive restructuring, and relapse prevention. Methods Fifty-five female adolescents with mental health problems due to single rape, but without prior sexual trauma, received STEPS while their parents participated in a support group. Subjects were assessed on posttraumatic stress (PTS) and comorbid symptoms using self-report questionnaires prior to and directly after treatment, and at 6 and 12 months follow-up. Results Repeated measures analysis showed a significant and large decrease in symptoms of PTS, anxiety, depression, anger, dissociation, sexual concerns, and behavior problems directly after treatment, which maintained at 12 months follow-up. Time since trauma did not influence the results. Dropout during STEPS was 1.8%. Conclusions The results potentially suggest that the positive treatment outcomes at short- and long-term may be caused by STEPS. The encouraging findings need confirmation in future controlled studies on the effectiveness of STEPS because it may be possible that the treatment works especially well for more chronic symptoms, while the less chronic part of the sample showed considerable improvement on its own.

Pathophysiological domains underlying the metabolic syndrome: an alternative factor analytic strategy

PURPOSE Factor analysis (FA) has become part and parcel in metabolic syndrome (MBS) research. Both exploration- and confirmation-driven factor analyzes are rampant. However, factor analytic results on MBS differ widely. A situation that is at least in part attributable to misapplication of FA. Here, our purpose was (i) to review factor analytic efforts in the study of MBS with emphasis on misusage of the FA model and (ii) to propose an alternative factor analytic strategy. METHODS The proposed factor analytic strategy consists of four steps and confronts weaknesses in application of the FA model. At its heart lies the explicit separation of dimensionality and pattern selection and the direct evaluation of competing inequality-constrained loading patterns. A high-profile MBS data set with anthropometric measurements on overweight children and adolescents is reanalyzed using this strategy. RESULTS The reanalysis implied a more parsimonious constellation of pathophysiological domains underlying phenotypic expressions of MBS than the original analysis (and many other analyses). The results emphasize correlated factors of impaired glucose metabolism and impaired lipid metabolism. CONCLUSIONS Pathophysiological domains underlying phenotypic expressions of MBS included in the analysis are driven by multiple interrelated metabolic impairments. These findings indirectly point to the possible existence of a multifactorial etiology.

Recording and accounting for stakeholder involvement in systematic reviews

OBJECTIVES The use of stakeholders in systematic reviews is increasingly valued, but their influence on the systematicity of the review is often unclear. The aim of this study was to describe some of the processes of involvement of stakeholders and to demonstrate a Tool for Recording and Accounting for Stakeholder Involvement (TRASI). METHODS We demonstrate the TRASI in two worked examples. In one project, the reviewers collaborated with the end-user and an expert during the literature search. In the other project, experts were consulted to generate keywords before searching the literature. RESULTS In the first project, disagreements about keywords to identify studies for the research topic were solved by informal discussion. In the second project, difficulties arose in reaching agreement between experts and reviewers about the core construct and the meaningful keywords associated with it. DISCUSSION The TRASI aids researchers to systematically and transparently account for the decisions taken. The TRASI supports information specialists and librarians to shape the search strategy to match the objectives of the review. CONCLUSIONS We propose the TRASI as a first step in resolving the challenges of detecting and reconstructing stakeholder influences. Potential new applications of the TRASI are discussed.

Using the realist perspective to link theory from qualitative evidence synthesis to quantitative studies: broadening the matrix approach.

BACKGROUND This study describes an approach for the use of a specific type of qualitative evidence synthesis in the matrix approach, a mixed studies reviewing method. The matrix approach compares quantitative and qualitative data on the review level by juxtaposing concrete recommendations from the qualitative evidence synthesis against interventions in primary quantitative studies. However, types of qualitative evidence syntheses that are associated with theory building generate theoretical models instead of recommendations. Therefore, the output from these types of qualitative evidence syntheses cannot directly be used for the matrix approach but requires transformation. This approach allows for the transformation of these types of output. METHOD The approach enables the inference of moderation effects instead of direct effects from the theoretical model developed in a qualitative evidence synthesis. Recommendations for practice are formulated on the basis of interactional relations inferred from the qualitative evidence synthesis. In doing so, we apply the realist perspective to model variables from the qualitative evidence synthesis according to the context-mechanism-outcome configuration. FINDINGS A worked example shows that it is possible to identify recommendations from a theory-building qualitative evidence synthesis using the realist perspective. We created subsets of the interventions from primary quantitative studies based on whether they matched the recommendations or not and compared the weighted mean effect sizes of the subsets. The comparison shows a slight difference in effect sizes between the groups of studies. The study concludes that the approach enhances the applicability of the matrix approach.